Appendix Assessment Descriptors For EM WPBA And ACCS Specialty

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					      Appendix 2


Assessment Descriptors
         For
     EM WPBA’s
         And
ACCS Specialty Specific
  Assessments forms




       CEM
      May 2010




           0
                            Table of Contents                            Page
Emergency Medicine WPBA forms                                              3
       MiniCex                                                             3
       Summative Mini-CEX form                                             3
       Formative Mni-CEX                                                   4
       Mini-CEX Descriptor of unsatisfactory performance                   5
       ACCS Mini-CEX Summative Descriptors for Major Presentation          7
                1. Anaphylaxis                                             7
                2. Unconscious patient                                     9
                3. Shock                                                  11
                4. Major trauma                                           12
                5. Sepsis                                                 13
       ACCS Mini-CEX Summative Descriptors for Acute Presentation         16
                1. Chest pain                                             16
                2. Abdominal pain                                         17
                3. Breathlessness                                         18
                4. Mental Health                                          19
                5. Head injury                                            21
       CbD                                                                23
       Summative CbD form                                                 23
       Formative CbD form                                                 24
       CbD descriptors                                                    25
       DOPs                                                               26
       EM DOPs form                                                       26
       Practical procedures DOPs descriptors                              27
                1. Airway                                                 27
                2. Primary survey                                         27
                3. Wound assessment                                       28
                4. Fracture and large joint dislocation                  29/30
       ACAT-EM                                                            31
       Instructions for use of ACAT-EM                                    31
       ACAT-EM form                                                       33
       MSF – EM                                                           34
       Patient survey tool - EM                                           35
Acute Medicine WPBA forms                                                 36
              1. Mini-CEX                                                 37
              2. CbD                                                      39
              3. DOPS                                                     41
              4. ACAT                                                     43
              5. Audit assessment                                         46
              6. Teaching Observation                                     48
Speciality specific assessments for Anaesthesia                           50
       Initial Assessment of Competence Cerificate                        50
       Assessments to be used for the initial Assessment of Competence    52
                1. A-CEX                                                  53
                2. DOPs                                                   55
                3. CbD                                                    57
Speciality specific assessments forms for ICM                             60
              1.   Mini-CEX                                               60
              2.   CbD                                                    61
              3.   DOPS                                                   62
              4.   MSF                                                    63
PEM CT3                                                                   65
       PEM CT3 Mini-CEX Summative descriptors for Acute Presentation      65
                                             1
          1. Abdominal pain                                                  65
          2. Fever                                                           66
          3. Breathlessness                                                  67
          4. Pain                                                            68
       PEM Practical procedures DOPs descriptors                             70
          1. Venous access                                                   70
          2. Airway assessment and maintenance,                              71
          3. Safe sedation in children,                                      71
          4. Paediatric equipment and Guidelines in the resuscitation room   72
          5. Primary survey                                                  72
Sub Speciality PEM ST7 Assessments                                           74
       SAIL, Guidance and forms                                              74
Structured Training Reports - STRs                                           78
              CT1 EM                                                         78
              CT1 AM                                                         82
              CT2 Anaesthesia                                                86
              CT2 ICM                                                        90
              CT3 PEM                                                        94
              CT3 EM                                                         98
              ST4 EM                                                         102
              ST5 EM                                                         106
              ST6 EM                                                         110
              PEM ST7 SS training                                            114




                                               2
                                      College of Emergency Medicine
                            Summative Mini-Clinical Evaluation Exercise - Mini-CEX
Name of trainee:                                                                        Year of Training:

Assessor:                                                                               GMC No:

Grade of assessor:                                                                      Date                            /    /

Case discussed (brief description)                                  Diagnosis


Focus of assessment –
History                                  Examination          Diagnosis            Management                     Communication



                                                                                     Demonstrates good practice
                                                                Further core                                                 Demonstrates
Please TICK to indicate the standard                          learning needed                                               excellent practice
of the trainee’s performance in each           Not observed                       Must address       Should address
                 area                                                            learning points     learning points
                                                                                highlighted below   highlighted below

Initial approach


History and information gathering


Examination


Investigation


Clinical decision making and judgment


Communication with patient, relatives,
staff


Overall plan


Professionalism


For summative Mini-CEX                                                                                Unsuccessful               Successful

Things done particularly well


Learning points


Action points


Assessor Signature:                                                Trainee Signature:




                                                                   3
                                       College of Emergency Medicine
                             Formative Mini-Clinical Evaluation Exercise - Mini-CEX
Name of trainee:                                                                        Year of Training:

Assessor:                                                                               GMC No:

Grade of assessor:                                                                      Date                            /    /

Case discussed (brief description)                                  Diagnosis


Focus of assessment –
History                                  Examination          Diagnosis            Management                     Communication



                                                                                     Demonstrates good practice
                                                                Further core                                                 Demonstrates
Please TICK to indicate the standard                          learning needed                                               excellent practice
of the trainee’s performance in each           Not observed                       Must address       Should address
                 area                                                            learning points     learning points
                                                                                highlighted below   highlighted below

Initial approach


History and information gathering


Examination


Investigation


Clinical decision making and judgment


Communication with patient, relatives,
staff


Overall plan


Professionalism

Things done particularly well


Learning points


Action points


Assessor Signature:                                                Trainee Signature:




                                                                   4
    Mini-CEX Descriptors for Unsatisfactory performance

Dimension                     Descriptor of unsatisfactory performance

History taking                History taking was not focused
                                 Did not recognise the critical symptoms, symptom patterns
                                 Failed to gather all the important information from the patient,
                                  missing important points
                                 Did not engage with the patient
                                 Was unable to elicit the history in difficult circumstances- busy,
                                  noisy, multiple demands

Physical examination          Failed to detect /elicit and interpret important physical signs
                              Did not maintain dignity and privacy

Communication                 Communication skills with colleagues
                                 Did not listen to other views
                                 Did not discuss issues with the team
                                 Failed to follow the lead of others when appropriate
                                 Rude to colleagues
                                 Did not give clear and timely instructions
                                 Inconsiderate of the rest of the team
                                 Was not clear in referral process- was it for opinion, advice, or
                                  admission
                              Communication with patients
                                 Did not elicit the concerns of the patient, their understanding of
                                  their illness and what they expect
                                 Did not inform and educate patients/carers
                                 Did not encourage patient involvement/ partnership in decision
                                  making

Clinical judgement-clinical      Did not identify the most likely diagnosis in a given situation
decision making
                                 Was not discriminatory in the use of diagnostic tests
                                 Did not construct a comprehensive and likely differential
                                  diagnosis
                                 Did not correctly identify those who need admission and those
                                  who can be safely discharged.
                                 Did not recognise atypical presentation
                                 Did not recognise the urgency of the case
                                 Did not select the most effective treatments
                                 Did not make decisions in a timely fashion
                                 Decisions did not reflect clear understanding of underlying
                                  principles

                                                 5
                                 Did not reassess the patient
                                 Did not anticipate interventions and slow to respond
                                 Did not review effect of interventions

Professionalism                  Did not respect confidentiality
                                 Did not protect the patients dignity
                                 Insensitive to patients opinions/hopes/fears
                                 Did not explain plan and risks in a way the patient could
                                  understand

Organisation and efficiency   Was slow to progress the case

Overall care                     Did not ensure patient was in a safe monitored environment
                                 Did not anticipate or recognise complications
                                 Did not focus sufficiently on safe practice
                                 Did not follow published standards guidelines or protocols
                                 Did not follow infection control measures
                                 Did not safely prescribe




                                                 6
     ACCS Mini-CEX Summative Descriptors for Major Presentations
        1. Anaphylaxis
        2. Unconscious/Altered Mental State
        3. Shock
        4. Trauma
        5. Sepsis

     Note that MP2 - Cardio Respiratory Arrest can by covered during anaesthesia as part
     of the Initial Assessment of Competence sign off.

1 Anaphylaxis

                    Expected behaviour                          Descriptor of Unsatisfactory
                                                                performance

Initial approach       ABCD approach, including GCS
                       Asks for vital signs including SPaO2,
                        blood sugar
                       Requests monitoring
                       Recognises physiological
                        abnormalities
                       Looks for obvious cause of shock
                        e.g. bleeding
                       Secures iv access

History                Obtains targeted history from              History taking was not focused
                        patient
                                                                   Did not recognise the critical
                       Obtains collateral history form             symptoms, symptom patterns
                        friends, family, paramedics- cover
                                                                   Failed to gather all the important
                        PMH
                                                                    information from the patient,
                       Recognises the importance of                missing important points
                        treatment before necessarily
                                                                   Did not engage with the patient
                        getting all information
                                                                   Was unable to elicit the history in
                       Obtains previous notes
                                                                    difficult circumstances- busy, noisy,
                                                                    multiple demands

Examination         Detailed physical examination which            Failed to detect /elicit and
                    must include physical signs that would          interpret important physical signs
                    differente between haemorragic,
                                                                   Did not maintain dignity and
                    hypovolaemic , cardiogenic and septic
                                                                    privacy
                    causes for shock

Investigation       Asks for appropriate tests-
                           arterial blood gas or venous gas and lactate
                           FBC,
                           U&Es,
                           clotting studies,


                                                  7
                           LFTs, toxicology,
                           Cross match as indicated
                           blood and urine culture,
                           CK and troponin,
                           ECG,
                           CXR,
                           Familiar with use of US to look for IVC compression and cardiac
                            tamponade

Clinical decision   Forms diagnosis and differential                Did not identify the most likely
making and          diagnosis including:                             diagnosis in a given situation
judgement
                           Trauma-haemorrhagic, blood              Was not discriminatory in the
                            loss control form direct                 use of diagnostic tests
                            pressure, pelvic splintage,
                                                                    Did not construct a
                            emergency surgery or
                                                                     comprehensive and likely
                            interventional radiology
                                                                     differential diagnosis
                           Gastrointestinal - upper and
                                                                    Did not correcty identify those
                            lower GI bleed, or fluid loss
                                                                     who need admission and those
                            form D&V
                                                                     who can be safely discharged.
                           Cardiogenic - STEMI, tachy and
                                                                    Did not recognise atypical
                            brady dysrhythmia
                                                                     presentation
                           Infection- sepsis, knows sepsis
                                                                    Did not recognise the urgency
                            bundle
                                                                     of the case
                           Endocrine - Addison’s disease,
                                                                    Did not select the most
                            DKA
                                                                     effective treatments
                           Neurological - neurogenic
                                                                    Did not make decisions in a
                            shock
                                                                     timely fashion
                           Poisoning - TCAs, cardio toxic
                                                                    Decisions did not reflect clear
                            drugs
                                                                     understanding of underlying
                                                                     principles
                                                                    Did not reassess the patient
                                                                    Did not anticipate
                                                                     interventions and slow to
                                                                     respond
                                                                    Did not review effect of
                                                                     interventions

Communication       Effectively communicates with both        Communication skills with colleagues
                    patient and colleagues
                                                                    Did not listen to other views
                                                                    Did not discuss issues with the
                                                                     team
                                                                    Failed to follow the lead of
                                                                     others when appropriate
                                                                    Rude to colleagues
                                                                    Did not give clear and timely
                                                 8
                                                                    instructions
                                                                   Inconsiderate of the rest of the
                                                                    team
                                                                   Was not clear in referral
                                                                    process- was it for
                                                                    opinion,advice, or admission
                                                             Communication with patients
                                                                   Did not elicit the concerns of
                                                                    the patient, their
                                                                    understanding of their illness
                                                                    and what they expect
                                                                   Did not inform and educate
                                                                    patients/carers
                                                                   Did not encourage patient
                                                                    involvement/ partnership in
                                                                    decision making

Organisation and                                                   Was slow to progress the case
efficency

Overall plan        Identifies immediate life threats and          Did not ensure patient was in a
                    readily reversible causes                       safe monitored environment
                    Stabilises and prepares for further            Did not anticipate or recognise
                    investigation, treatment and admission          complications
                                                                   Did not focus sufficiently on
                                                                    safe practice
                                                                   Did not follow published
                                                                    standards guidelines or
                                                                    protocols
                                                                   Did not follow infection control
                                                                    measures
                                                                   Did not safely prescribe

Professionalism     Behaves in a professional manner               Did not respect confidentiality
                                                                   Did not protect the patients
                                                                    dignity
                                                                   Insensitve to patients
                                                                    opinions/hopes/fears
                                                                   Did not explain plan and risks
                                                                    in a way the patient could
                                                                    understand


2 Unconscious/altered mental status

                    Expected behaviour

Initial approach       ABCD approach, including GCS

                                                 9
                       Asks for vital signs including SPaO2, blood sugar
                       Secures iv access
                       Looks for lateralising signs, pin point pupils, signs of trauma, considers neck
                        injury
                       Considers opiate OD, alcoholism, anticoagulation

History                Obtains history- friends, family, paramedics- cover PMH, previous ODs etc
                       Obtains previous notes

Examination         Detailed physical examination including fundoscopy

Investigation       Asks for appropriate tests
                           arterial blood gas
                           FBC
                           U&Es
                           clotting studies
                           LFTs, toxicology
                           blood and urine culture
                           CK and troponin
                           HbCO
                           ECG
                           CXR
                           and CT

Clinical decision   Forms diagnosis and differential diagnosis including:
making and
                           Trauma- SAH, Epidural and subdural
judgement
                           Neurovascular- stroke, hypertensive encephalopathy
                           Cardiovascular- dysrhythmia, hypotension
                           Neuro- seizure or post ictal
                           Infection- meningitis, encephalitis, sepsis
                           Organ failure- pulmonary, renal, hepatic
                           Metabolic- glucose, sodium, thyroid disease, temperature
                           Poisoning
                           Psychogenic

Communication       Effectively communicates with both patient and colleagues

Overall plan        Identifies immediate life threats and readily reversible causes
                    Stabilises and prepares for further investigation, treatment and admission

Professionalism     Behaves in a professional manner




                                                 10
3 Shock

                    Expected behaviour

Initial approach       ABCD approach, including GCS
                       Asks for vital signs including SPaO2, blood sugar
                       Requests monitoring
                       Recognises physiological abnormalities
                       Looks for obvious cause of shock e.g. bleeding
                       Secures iv access

History                Obtains targeted history from patient
                       Obtains collateral history form friends, family, paramedics- cover PMH
                       Recognises the importance of treatment before necessarily getting all
                        information
                       Obtains previous notes

Examination         Detailed physical examination which must include physical signs that would
                    differente between haemorragic, hypovolaemic , cardiogenic and septic causes
                    for shock

Investigation       Asks for appropriate tests
                           arterial blood gas or venous gas and lactate
                           FBC
                           U&Es
                           clotting studies
                           LFTs, toxicology
                           Cross match as indicated
                           blood and urine culture
                           CK and troponin
                           ECG
                           CXR
                           Familiar with use of US to look for IVC compression and cardiac
                            tamponade

Clinical decision   Forms diagnosis and differential diagnosis including:
making and
                           Trauma-haemorrhagic, blood loss control form direct pressure, pelvic
judgement
                            splintage, emergency surgery or interventional radiology
                           Gastrointestinal - upper and lower GI bleed, or fluid loss form D&V
                           Cardiogenic - STEMI, tachy and brady dysrhythmia,
                           Infection- sepsis, knows sepsis bundle
                           Endocrine - Addison’s disease, DKA
                           Neurological - neurogenic shock
                                                 11
                           Poisoning - TCAs, cardio toxic drugs

Communication       Effectively communicates with both patient and colleagues

Overall plan        Identifies immediate life threats and readily reversible causes
                    Stabilises and prepares for further investigation, treatment and admission

Professionalism     Behaves in a professional manner


4 Major trauma

                    Expected behaviour

Initial approach       Knows when to activate the trauma team (based on local guidelines)
                       Able to perform a rapid primary survey, including care of the c spine and
                        oxygen delivery
                       Can safely log roll patient off spinal board
                       Able to assess disability, using AVPU or GCS
                       Asks for vital signs
                       Able to request imaging at end of primary survey
                       Knows when to request specialty opinion and/or further imaging

History                Obtains history of mechanism of injury from paramedics
                       Able to use AMPLE history

Examination         After completing a primary survey is able to perform
                           detailed secondary survey

Investigation       Asks for appropriate tests
                           Primary survey films
                           CT imaging
                           arterial blood gas
                           FBC
                           U&Es
                           clotting studies
                           PT
                           toxicology
                           ECG
                           FAST
                           UO by catheterisation
                           Appropriate use of NG

Clinical decision   Forms differential diagnosis and management plan based on:
making and
                           Able to identify and mange life threatening injuries as part of primary

                                                   12
judgement                  survey
                          Able to identify the airway that may be at risk
                          Can identify shock, know it classification and treatment
                          Safely prescribes fluids, blood products and drugs.
                          Can identify those patients who need urgent interventions or surgery
                           before imaging or secondary survey
                          Can safely interpret imaging and test results
                          Demonstrates safe disposition of trauma patient after secondary survey
                          Able to identify those patients that be safely discharged home

Communication      Effectively communicates with both patient and other members of the trauma
                   team

Overall plan       Identifies immediate life threats and readily reversible causes
                   Stabilises and prepares for further investigation, treatment and admission

Professionalism    Behaves in a professional manner


5 Sepsis

                   Expected behaviour

Initial approach   Initial approach based on ABCD system- ensuring early monitoring of vital signs
                   including temperature,SPaO2, blood sugar
                      Can interpret early warning medical score as indicators of sepsis (EMEWS or
                       similar)
                      Aware of systemic inflammatory response criteria (SIRS), and that 2 or more
                       may indicate sepsis
                           o     T>38 or < 36
                           o     HR > 90
                           o     RR > 20
                           o     WCC > 12 or < 4

History               Obtains history of symptoms leading up to illness
                      Able to take a collateral history, form paramedics, friends and family
                      Able to use AMPLE history
                      Looks specifically for conditions causing immunocompromise

Examination        Able to perform a competent examination looking for
                      Possible source of infection
                      Secondary organ failure

Investigation      Asks for appropriate tests
                          FBC


                                                   13
                           U&Es
                           clotting studies
                           ABGs or VBGs
                           Lactate, ScVo2
                           Blood cultures
                           ECG
                           CXR
                           Urinalysis +/- catheterisation
                           Other interventions which may help find source of sepsis
                                  o     Swabs
                                  o     PCR
                                  o     Pus
                    Considers need for further imaging

Clinical decision   Form a management plan with initial interventions being:
making and
                           Oxygen therapy
judgement
                           Fluid bolus, starting with 20 mls/Kg
                           IV Antibiotics, based on likely source of infection
                           Documentation of a physiological score, which can be repeated
                           Be able to reassess
                    Recognises and is able to support physiological markers of organ dysfunction,
                    such as:-
                           Systolic BP < 90 mm Hg
                           PaO2 < 8 Kpa
                           Lactate > 5
                           Reduced GCS
                           Urine output < 30 mls/hr
                    Demonstrates when to use invasive monitoring, specifically
                           CVP line
                           Arterial line
                    Demonstrates when to start inotropes, Noradrenaline v dopamine
                    Demonstrates how to set up an inotrope infusion

Communication       Effectively communicates with both patient and other members of the acute care
                    team

Overall plan        Identifies sepsis
                    Implements 4 hour sepsis bundle
                    Stabilises patient, reassesses and able to inform and/or hand over to critical care
                    team


                                                  14
Professionalism   Behaves in a professional manner




                                             15
    ACCS Mini-CEX Summative Descriptors for Acute Presentations
       1. Chest pain
       2. Abdominal pain
       3. Breathlessness
       4. Mental Health
       5. Head Injury

1 Chest pain.

                          Expected behaviours

Initial approach             Ensures monitoring, i.v. access and defibrillator nearby.
                             Ensures vital signs are measured including SpO2

History                      Takes focused history (having established conscious with patent
                              airway) of chest pain including
                                  o   site
                                  o   severity
                                  o   onset
                                  o   nature
                                  o   radiation
                                  o   duration
                                  o   frequency
                                  o   precipitating and relieving factors
                                  o   Previous similar pains and associated symptoms
                             Systematically explores for symptoms of life threatening chest
                              pain
                             Assesses ACS risk factors
                             Specifically asks about previous medication and past medical
                              history
                             Seeks information from paramedics, relatives and past medical
                              notes including previous ECGs

Examination               On examination has ABCD approach with detailed cardiovascular and
                          respiratory examination including detection of peripheral pulses,
                          blood pressure measurement in both arms, elevated JVP, palpation of
                          apex beat, auscultation e.g. for aortic stenosis and incompetence,
                          pericardial rub, signs of cardiac failure, and pleural rubs

Investigation             Ensures appropriate investigation
                             ECG (serial)
                             ABG
                             FBC, U&Es
                             troponin and d dimer if indicated
                             Chest x-ray

                                              16
Communication                  Effectively communicates with both patient and colleagues

Prescribing                    Able to relieve pain by appropriate prescription

Clinical decision making and   Able to formulate a full differential diagnosis and the most likely
judgement                      cause in this case.



Overall plan                   Stabilises and safely prepares the patient for further treatment and
                               investigation

Professionalism                Behaves in a professional manner


2 Abdominal pain

                          Expected behaviours

Initial approach              Ensures appropriate monitoring in place and iv access
                              Establishes that vital signs measured

History                       Takes focused history of abdominal pain including
                                   o   site
                                   o   severity
                                   o   onset
                                   o   nature
                                   o   radiation
                                   o   duration
                                   o   frequency
                                   o   precipitating and relieving factors
                                   o   previous similar pains and associated symptoms
                              Systematically explores for symptoms of life threatening abdominal
                               pain
                              Specifically asks about previous abdominal operations
                              Considers non abdominal causes- MI, pneumonia, DKA,
                               hypercalcaemia, sickle, porphyria
                              Seeks information from paramedics, relatives and past medical notes

Examination               Able to undertake detailed examination for abdominal pain (ensuring
                          adequate exposure and examining for the respiratory causes of abdominal
                          pain) including
                          o    Inspection, palpation, auscultation and percussion of the abdomen
                          o    Looks for herniae and scars
                          o    Examines loins, genitalia and back
                          o    Undertakes appropriate rectal examination


                                                   17
Investigation              Ensures appropriate investigation-
                               o   ECG
                               o   ABG
                               o   FBC
                               o   U&Es
                               o   LFTs
                               o   amylase
                               o   erect chest x-ray
                               o   and abdominal x-rays if obstruction or perforation suspected

Clinical decision making   Able to formulate a full differential diagnosis and the most likely cause in
and judgement              this case

Communication              Effectively communicates with both patient and colleagues

Prescribing                Able to relieve pain by appropriate prescription

Overall plan               Stabilises (if appropriate)and safely prepares the patient for further
                           treatment and investigation

Professionalism            Behaves in a professional manner


3 Breathlessness

                           Expected behaviours

Initial approach           o   Ensures monitoring, iv access gained, O2 therapy
                           o   Ensures vital signs are measured including Spa O2

History                    o   If patient able, trainee takes focused history of breathlessness
                               including onset,
                                         severity
                                         duration
                                         frequency
                                         precipitating and relieving factors
                                         previous similar episodes
                                         associated symptoms
                           o   Systematically explores for symptoms of life threatening causes of
                               breathlessness
                           o   Takes detailed respiratory history
                           o   Specifically asks about medication and past medical history
                           o   Seeks information from paramedics, relatives and past medical notes
                               including previous chest x-rays and blood gases

Examination                On examination has ABCD approach with detailed cardiovascular and

                                                      18
                           respiratory examination including, work of breathing, signs of
                                  respiratory distress
                                  detection of wheeze
                                  crepitations
                                  effusions
                                  areas of consolidation

Investigation              Ensures appropriate investigation
                                  ECG
                                  ABG
                                  FBC
                                  U&Es
                                  troponin and d dimer if indicated
                                  Chest x-ray
                           Able to interpret chest x-ray correctly

Clinical decision making   Able to formulate a full differential diagnosis and the most likely cause in
and judgement              this case
                           Knows BTS guidelines for treatment of Asthma and PE

Communication              Effectively communicates with both patient and colleagues

Prescribing                   Able to prescribe appropriate medication including oxygen therapy,
                               bronchodilators, GTN, diuretics
                              Able to identify which patients would benefit from NIV

Overall plan               Stabilises and safely prepares the patient for further treatment and
                           investigation

Professionalism            Behaves in a professional manner


4 Mental Health
Mental health issues are a common problem within the ED (typically combinations of overdose, DSH,
suicidal ideation but also psychotic patients). Selection of patients suitable for min-CEX assessment
must be undertaken thoughtfully.

                       Expected behaviours

Initial approach       Ensures assessment takes place in a safe environment.

History                History taking covers
                              presenting complaint,
                              past psychiatric history,
                              family history,
                              work history,

                                                  19
                             sexual/marital history,
                             substance misuse,
                             forensic history,
                             social circumstances,
                             personality.
                    Undertakes mental state examination covering
                             appearance and behaviour
                             speech
                             mood
                             thought abnormalities
                             hallucinations
                             cognitive function using the mini mental state examination
                             insight
                    Elicits history sympathetically, is unhurried
                    Searches for collateral history- friends and relatives, general practitioner,
                    past medical notes, mental health workers

Examination         Ensures vital signs are measured
                    Undertakes physical examination looks for physical causes of psychiatric
                    symptoms- head injury, substance withdrawal, thyroid disease, intoxication,
                    and hypoglycaemia

Investigation       Ensures appropriate tests
                       U&E
                       FBC
                       CXR
                       CT
                       toxicology

Clinical decision   Ensures no organic cause for symptoms
making and
                    Forms working diagnosis and assessment of risk- specifically of suicide and
judgement
                    toxicological risk in those with overdoses

Communication       Effectively communicates with both patient and colleagues

Prescribing         Knows safe indications, routes of administration of common drugs for
                    chemical sedation

Overall plan        Identifies appropriately those who will need further help as an inpatient and
                    who can be followed up as an out patient
                    Is able to assess capacity
                    Have strategies for those who refuse assessment or treatment or who
                    abscond



                                                  20
Professionalism     Behaves in a professional manner


5 Head Injury

                    Expected behaviours

Initial approach    Ensures ABC are adequate and that neck is immobilised in the unconscious
                    patient and those with neck pain. Ensures BM done

History                Establishes history-
                            o     mechanism of injury
                            o     any loss of consciousness and duration
                            o     duration of any amnesia
                            o     headache
                            o     vomiting
                            o     associated injuries especially facial and ocular
                       Establishes if condition is worsening
                       Gains collateral history from paramedics, witnesses, friends/relatives and
                        medical notes
                       Establishes if taking anticoagulants, is epileptic

Examination         After ABC undertakes systematic neuro examination including
                           GCS
                           papillary reactions and size
                           cranial nerve and peripheral neurological examination
                           and seeks any cerebellar signs
                           Looks for signs of basal skull fracture
                           Examines scalp
                           Looks for associated injuries- neck, facial bones including jaw
                           Actively seeks injuries elsewhere

Investigation       Is able to identify the correct imaging protocol for those with potentially
                    significant injury -specifically the NICE guidelines

Clinical decision   Is able to refer appropriately with comprehensive and succinct summary
making and
                    Knows which patients should be referred to N/surgery
judgement
                    Is able to identify those patients suitable for discharge and ensures safe
                    discharge.

Communication       Effectively communicates with both patient and colleagues

Prescribing         Able to safely relieve pain in the head injured patient

Overall plan        Stabilises and safely prepares the patient for further treatment and
                    investigation or safely discharges patient

                                                 21
Professionalism   Behaves in a professional manner




                                           22
                                                 College of Emergency Medicine
                                              Summative Case Based Discussion CbD
Name of trainee:                                                                             Year of Training:

Assessor:                                                                                    GMC No:

Grade of assessor:                                                                           Date                            /    /

Case discussed (brief description)                                       Diagnosis




                                                                                          Demonstrates good practice
                                                                  Further core                                                    Demonstrates
 Please TICK to indicate the standard                           learning needed                                                  excellent practice
 of the trainee’s performance in each            Not observed                          Must address       Should address
                  area                                                                learning points     learning points
                                                                                     highlighted below   highlighted below

Record keeping


Review of investigations


Diagnosis


Treatment


Planning for subsequent care (in patient or
discharged patients)

Clinical reasoning


Patient safety issues


Overall clinical care


For summative CbD                                                                                         Unsatisfactory              Satisfactory

Things done particularly well


Learning points


Action points


Assessor Signature:                                                  Trainee Signature:




                                                                    23
                                                 College of Emergency Medicine
                                              Formative Case Based Discussion CbD
Name of trainee:                                                                            Year of Training:

Assessor:                                                                                   GMC No:

Grade of assessor:                                                                          Date                            /    /

Case discussed (brief description)                                      Diagnosis




                                                                                         Demonstrates good practice
                                                                 Further core                                                    Demonstrates
 Please TICK to indicate the standard                          learning needed                                                  excellent practice
 of the trainee’s performance in each           Not observed                          Must address       Should address
                  area                                                               learning points     learning points
                                                                                    highlighted below   highlighted below

Record keeping


Review of investigations


Diagnosis


Treatment


Planning for subsequent care (in patient or
discharged patients)

Clinical reasoning


Patient safety issues


Overall clinical care


Things done particularly well


Learning points


Action points


Assessor Signature:                                                 Trainee Signature:




                                                                   24
CbD descriptors

Domain descriptor

Record keeping             Records should be legible and signed. Should be structured and
                           include provisional and differential diagnoses and initial
                           investigation & management plan. Should record results and
                           treatments given.

Review of investigations   Undertook appropriate investigations. Results are recorded and
                           correctly interpreted. Any Imaging should be reviewed in the
                           light of the trainees interpretation

Diagnosis                  The correct diagnosis was achieved with an appropriate
                           differential diagnosis. Were any important conditions omitted?

Treatment                  Emergency treatment was correct and response recorded.
                           Subsequent treatments appropriate and comprehensive

Planning for subsequent    Clear plan demonstrating expected clinical course, recognition of
care (in patient or        and planning for possible complications and instructions to
discharged patients)       patient (if appropriate)

Clinical reasoning         Able to integrate the history, examination and investigative data
                           to arrive at a logical diagnosis and appropriate treatment plan
                           taking into account the patients co morbidities and social
                           circumstances

Patient safety issues      Able to recognise effects of systems, process, environment and
                           staffing on patient safety issues

Overall clinical care      The case records and the trainees discussion should demonstrate
                           that this episode of clinical care was conducted in accordance
                           with good clinical practice and to a good overall standard




                                             25
                                                College of Emergency Medicine
                                         Direct Observation of procedural Skills - DOPs
Name of trainee:                                                                            Year of Training:

Assessor:                                                                                   GMC No:

Grade of assessor:                                                                          Date                         /     /

Procedure observed (including indications)




                                                                             Demonstrates good practice
                                                          Further core
                                                 Not        learning                                            Demonstrates excellent practice
Please TICK to indicate the standard of the                                Must address     Should address
                                                             needed
    trainee’s performance in each area         observed                   learning points   learning points
                                                                            highlighted       highlighted
                                                                               below             below

Indication for procedure discussed with
assessor

Obtaining informed consent

Appropriate preparation including
monitoring, analgesia and sedation

Technical skills and aseptic technique

Situation awareness and clinical judgement

Safety, including prevention and
management of complications
Care /investigations immediately post
procedure
Professionalism, communication and
consideration for patient, relatives and
staff

Documentation in the notes

Completed task appropriately

Things done particularly well


Learning points


Action points


Assessor Signature:                                                  Trainee Signature:




                                                                     26
          Practical procedures DOPs descriptors
             1. Basic airway
             2. Trauma - primary survey
             3. Wound management
             4. Fracture manipulation and joint reduction

1 Basic airway management including adjuncts e.g. BVM, oxygen delivery

Observed behaviour                                                                                       Task
                                                                                                       Completed

1. Is able to assess the adult airway and in the obstructed patient provide a patent airway by
   simple manoeuvres and the use of adjuncts and suction.

2. Undertakes this in a timely and systematic way.

3. Assesses depth of respiration and need for BVM.

4. Can successfully BVM.

5. Knows and can show how to deliver high flow 02

6. Knows other O2 delivery systems typically in ED- fixed concentration masks, nasal specs,
   Mapleson C circuits.

7. Consents the patient


2 Perform a primary survey of a potentially multiple injured trauma patient

Observed behaviour                                                                                       Task
                                                                                                       Completed

1. Ensures safe transfer of patient onto ED trolley

2. Assesses airway, establishes if obstructed, corrects and ensures delivery of 100%O2

3. Concurrently ensures cervical spine immobilisation (using collar, sandbags and tape)



4. Exposes chest identified raised respiratory rate, chest asymmetry, chest wall bruising, air entry
   (anteriorly and laterally) and percussion (laterally). Identifies life threatening problems and
   correctly carries out associated procedures

5. Examines for signs of shock, ensures monitoring established and has gained iv accessX2


6. If shocked looks for potential sites of blood loss- abdomen, pelvis and limbs.

7. Can formulate differential for shocked patient

8. Establishes level of consciousness and seeks lateralising signs

9. Examines limbs, spine and rectum ensuring safe log roll.

                                                        27
10. Will have identified and searched for potential life threatening problems in a systematic and
    prioritised way

11. Reassesses if any deterioration with repeat of ABCD

12. Elicits full relevant history from pre-hospital care providers

13. Ensured appropriate monitoring
14. Will have placed lines, catheter and NG tubes as appropriate

15. Ensured appropriate blood testing (including cross match).
16. Plain radiology trauma series undertaken

17. Ensures adequate and safe pain relief

18. Directs team appropriately

19. Notes of primary survey are clear and legible


3 Wound management

Observed behaviour                                                                                     Task
                                                                                                     Completed

1. Wound assessment- takes history of mechanism of injury, likely extent and nature of damage,
   and possibility of foreign bodies. Establishes tetanus status and drug allergies.

2. Assesses the wound- location, length, depth, contamination, and structures likely to be
   damaged

3. Establishes distal neurovascular and tendon status with systematic physical examination


4. Consents the patient

5. Provides wound anaesthesia (local infiltration, nerve or regional block).

6. Explores wound – identifies underlying structures and if damaged or not.

7. Ensures good mechanical cleansing of wound and irrigation.

8. Clear understanding of which wounds should not be closed

9. Closure of wound, if indicated, without tension, with good suture technique. Can place and tie
   sutures accurately.

10. Provides clear instructions to patient regarding follow up and suture removal and when to seek
    help.




                                                          28
4a Fracture manipulation e.g. Colles fracture

Observed behaviour                                                                                   Task
                                                                                                   Completed

1. Confirms correct patient, taken relevant history, and consented the patient. Explains to
   patient procedure and anticipated course

2. Interprets the x-ray correctly and looks for associated injuries

3. Ensures appropriate monitoring and resuscitation equipment available and another doctor to
   assist.

4. Typically reduction will involve the use of a Biers block (but could use haematoma block)


5. Patient weighed. Contraindications to Biers known and considered

6. Biers machine and resuscitation equipment checked

7. IV access gained both arms, affected side distal to fracture

8. Correct volume and concentration of local anaesthetic drawn up

9. Arm raised, padding applied to arm, brachial artery occluded

10. Cuff inflation to 100mmhg greater than patients systolic BP

11. Clock started, anaesthetic given slowly.

12. Ensure anaesthesia of fracture site.

13. Remove cannula from affected side.

14. Ensure counter-traction and traction

15. Reduce fracture, maintaining reduction and POP applied.

16. Knows how to size and apply POP

17. Check x-ray

18. Release of cuff slowly at 20 minutes post inflation

19. Continued observation of patient for signs of toxicity- peri oral paraesthesia, hypotension,
    seizures.

20. Check circulation to limb.

21. Ensures well one hour post procedure, ensures post procedure analgesia and indicates when
    patient to return and predicted course.




                                                          29
4b Reduction of a dislocated joint e.g. shoulder, ankle

Observed behaviour                                                                                   Task
                                                                                                   Completed

1. Confirms correct patient, takes focused history and consents the patient.

2. Takes focused history and examination to establish that sedation is safe.

3. Undertakes examination to confirm dislocation and assesses distal neurovascular function

4. Interprets the x-ray correctly and looks for associated injuries

5. Ensures appropriate monitoring and resuscitation equipment available and another doctor to
   assist.

6. Gains IV access, and has correct volume of opiate, benzodiazepine or other agent e.g.
   Ketamine, in correctly labelled syringes.

7. Knows the pharmacology of these drugs and their antagonists

8. Explains to patient procedure and anticipated course.

9. Ensures another doctor present

10. Gives drugs in controlled way in monitored environment with patient receiving oxygen.

11. Establishes sedated- still responsive to verbal commands.

12. Undertakes reduction in gentle and controlled manner.

13. Confirms reduction by physical examination and checks distal neurovascular function

14. Immobilises - sling, pop correct patient, taken relevant history, and consented the patient.
    Explains to patient procedure and anticipated course

15. Gets check x-ray- checks reduced and no additional fractures detected.

16. Ensures observed and monitored until fully recovered.

17. Rechecks neurovascular function

18. Ensures well one hour post procedure, ensures post procedure analgesia and indicates when
    patient to return and predicted course.




                                                          30
Instructions for Use of ACAT-EM
Testing of this tool in the ED has indicated that it may work best if:
1. The assessment is best conducted over more than one shift (typically 2-3) as not
   all the domains may be observed by the assessor in one shift. The assessor
   should ensure that as many domains are covered as possible
2. That the assessor should seek the views of other members of the ED team when
   judging performance
3. That the trainee should be aware when the ACAT is being undertaken
4. That clinical notes and drug prescriptions should be reviewed especially relating
   to patients cared for in the resuscitation room.
5. That this is an opportunity to follow up the care of the critically ill patients looked
   after during the ACAT –EM assessment.
6. The ACAT can be used to confirm knowledge, skills and attitudes for the cases
   reviewed by the assessor.
7. The CEM would recommend that an individual ACAT-EM does not cover more
   than 5 APs and that the case notes and management plan for each patient should
   be reviewed by the CS before it is signed off on the ACAT.
8. ACAT-EM can never be used as a summative tool
9. Could be used in a variety of setting within the ED- cdu ward rounds, clinics as
   well as major/minor/resuscitation and paediatric areas

ACAT –EM

Assessment Domains     Description

Clinical assessment    Quality of history and examination to arrive at appropriate
and clinical topics    diagnosis- made by direct observation in different areas especially in
covered                the resuscitation room.
                       No more than 5 AP should be covered in each ACAT and this should
                       involve a review of the notes and management plan of the patient.

Medical record         Quality of recording of patient encounters including drug and fluid
keeping                prescriptions

Investigations and     Quality of trainees choice of investigations and referrals
referrals

Management of          Quality of treatment given (assessment, investigation, urgent
patients               treatment given involvement of seniors)



Time management        Prioritisation of cases

Management of          Appropriate relationship with and involvement of other health
take/team working      professionals

Clinical leadership    Appropriate delegation and supervision of junior staff

Handover               Quality of handover of care of patients between EM and in patient
                       teams and in house handover including obs/CDU ward

Patient safety         Able to recognise effects of systems, process, environment and

                                                 31
                   staffing on patient safety issues

Overall clinical   Quality of trainees integrated thinking based on clinical assessment,
judgement          investigations and referrals. safe and appropriate management, use
                   of resources sensibly




                                         32
                                     College of Emergency Medicine
                             The Acute Care Assessment Tool (ACAT-EM) form
Name of trainee:                                                           GMC number

Assessor                                                                   Grade

Setting, ED, CDU, Clinic, other                                            Date

Timing, duration and level of
responsibility

Acute presentations covered (5 max
for EM)



                                                                                     Demonstrates good practice
                                                                Further core                                            Demonstrates
 Please TICK to indicate the standard of the                  learning needed      Must address     Should address    excellent practice
                                               Not observed
     trainee’s performance in each area                                           learning points   learning points
                                                                                    highlighted       highlighted
                                                                                       below             below

Clinical Assessment

Medical record keeping

Time management

Management of the team

Clinical leadership

Patient safety

Handover

Overall Clinical Judgement

Which aspects were done well                                            Learning points



Unsatisfactory AP?                                                      Plan for further AP assessment, specify WPBA tool and
                                                                        review date



Trainees Comments                                                       Action points



Assessors signature                                                     Trainees signature




                                                                33
               COLLEGE OF EMERGENCY MEDICINE MULTI-SOURCE FEEDBACK (MSF)
            Thank you very much for completing this form, which will help me to improve my strengths
            and weaknesses. This form is completely anonymous.
Name of trainee:                                                              Year of Training:

Grade of assessor:                                                            Date                      /   /



 UNKNOWN                    1                      2                 3                 4                     5
                      Performance           Performance        Performance    Performance Exceeds      Performance
Not Observed         Does Not Meet         Partially Meets        Meets           Expectations      Consistently Exceeds
                      Expectations          Expectations       Expectations                            Expectations

                    Good Clinical Care                         1-5 or UK                     Comments
1      Medical knowledge and clinical skills
2      Problem-solving skills
3      Note-keeping – clarity; legibility and completeness
4      Emergency Care skills
                   Relationships with Patients                 1-5 or UK
1      Empathy and sensitivity
2      Communicates well with all patient groups
3      Treats patients and relatives with respect
4      Appreciates the pyscho-social aspects of patient care
5      Offers explanations
                   Relationships with Colleagues               1-5 or UK
1      Is a team-player
2      Asks for others’ point of view and advice
3      Encourages discussion Empathy and sensitivity
4      Is clear and precise with instructions
5      Treats colleagues with respect
6      Communicates well (incl. non-vernal communication)
7      Is reliable
8      Can lead a team well
9      Takes responsibility
10     “I like working with this doctor”
                   Teaching and Training                       1-5 or UK
1      Teaching is structured
2      Is enthusiastic about teaching
3      This doctor’s teaching sessions are beneficial
4      Teaching is presented well
5      Uses varied teaching skills
                  Global ratings and concerns                  1-5 or UK
1      Overall how do you rate this Dr compared to other ST1
       Drs
2      How would you rate this trainees performance at this
       stage of training
3      Do you have any concerns over this Drs probity or
       health?




                                                               34
                   College of Emergency Medicine - Patient Survey Tool
      Communication with patients is a very important part of quality medical care. We would like
      to know how you feel about the way your doctor communicated with you. Your answers are
      completely confidential, so please be as open and as honest as you can.
      Thank you very much for your help and co-operation.



The doctor                                   Poor        Fair           Good     Very Good   Excellent

Greeted me in a way that made me feel         1            2             3          4           5
comfortable

Treated me with respect                       1            2             3          4           5

Showed interest in my ideas about my          1            2             3          4           5
health

Understood my main health concerns            1            2             3          4           5

Paid attention to me (looked at me and        1            2             3          4           5
listened carefully)

Let me talk without interruptions             1            2             3          4           5

Gave as much information as I wanted          1            2             3          4           5

Talked in terms I could understand            1            2             3          4           5

Checked to be sure I understood everything    1            2             3          4           5

Encouraged me to ask questions                1            2             3          4           5

Involved me in decisions as much as I         1            2             3          4           5
wanted

Discussed next steps including any follow     1            2             3          4           5
up plans

Showed care and concern                       1            2             3          4           5

Spent the right amount of time with me        1            2             3          4           5


      EM Doctors name:-                                         Validated by:-




                                                    35
Specialty Specific assessments for Acute Medicine

WPBA forms
      1. Mini-CEX
      2. CbD
      3. DOPS
      4. ACAT
      5. Audit assessment
      6. Teaching assessment




                                  36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
        Speciality specific assessments for Anaesthesia

        Assessments to be used for the initial Assessment of Competence - IAC
A-CEX                                                                                          Task
                                                                                             Completed

1. Preoperative assessment of a patient who is scheduled for a routine operating list (non
   urgent or emergency)

2. Manage anaesthesia for a patient who is not intubated and is breathing spontaneously

3. Administer anaesthesia for laparotomy

4. Demonstrate rapid sequence induction

5. Recover a patient form anaesthesia


DOPS                                                                                           Task
                                                                                             Completed

1. Demonstrate functions of the anaesthetic machine

2. Transfer a patient onto the Initial operating table and position them for surgery
   (lateral, Llloyd Davis or lithotomy position)

3. Demonstrate cardio-pulmonary resuscitation on a manikin.

4. Demonstrates technique of scrubbing up and donning gown and gloves.

5. Basic Competencies for Pain Management – manages PCA including prescription and
   adjustment of machinery


Case-Based Discussion                                                                          Task
                                                                                             Completed

1. Discuss the steps taken to ensure correct identification of the patient, the operation
   and the side of operation

2. Discuss how the need to minimise postoperative nausea and vomiting influenced
   the conduct of the anaesthetic

3. Discuss how the airway was assessed and how difficult intubation can be predicted

4. Discuss how the choice of muscle relaxants and induction agents was made

5. Discuss how the trainee’s choice of post-operative analgesics was made

6. Discuss how the trainee’s choice of post operative oxygen therapy was made

7. Discuss the problems emergency intra-abdominal surgery causes for the anaesthetist
   and how the trainee dealt with these



                                                    52
53
54
55
56
57
58
59
                                             ICM Mini-Clinical Evaluation Exercise
                                                              (ICM Mini-CEX)
 Name of trainee:                                                                            Year of Training:

 Assessor:                                                                                   GMC No:

 Grade of assessor:                                                                          Date                        /     /

 Case discussed (brief description)


 Focus of assessment –
 History                                  Examination             Diagnosis            Management                   Communication


                                                                Safe - supervision     Minimal supervision        No supervision and manages
                                                                    required                required                    complications
  Please TICK to indicate the standard         Not observed
                                                                       (BASIC)          (INTERMEDIATE)                   (ADVANCED)
  of the trainee’s performance in each          or practice
                                                  unsafe
                   area
                                                                                      Distant -     Distant –      Partially          Totally
                                                              Direct      Immediate
                                                                                       often          rare       independent       independent


 History and information gathering


 Immediate management and stabilisation


 Further management and decision making


 Clinical judgement

 Safety, including management
 plan/monitoring/help

 Communication with patient, relatives,
 staff

 Organisation/efficiency


 OVERALL CLINICAL CARE


 Things done particularly well



 Suggested areas for development



       Assessor                                                        Trainee


Signature:                                                               Signature:




                                                                         60
                                                  ICM Case- based discussion
                                                              (ICM CbD)
 Name of trainee:                                                                          Year of Training:

 Assessor:                                                                                 GMC No:

 Grade of assessor:                                                                        Date                        /     /

 Case discussed (brief description)




                                                              Safe - supervision     Minimal supervision        No supervision and manages
                                                                  required                required                    complications
  Please TICK to indicate the standard       Not observed
                                                                     (BASIC)          (INTERMEDIATE)                   (ADVANCED)
  of the trainee’s performance in each        or practice
                                                unsafe
                   area
                                                                                    Distant -     Distant –      Partially          Totally
                                                            Direct      Immediate
                                                                                     often          rare       independent       independent


 History and information gathering


 Immediate management and stabilisation


 Further management and decision making


 Safety, including management plan/help

 Communication with patient, relatives and
 staff

 Documentation in the notes


 OVERALL CLINICAL CARE


 Things done particularly well




 Suggested areas for development




       Assessor                                                      Trainee


Signature:                                                             Signature:




                                                                       61
                                            ICM Direct Observation of procedural Skills
                                                               (ICM DOPS)
Name of trainee:                                                                               Year of Training:

Assessor:                                                                                      GMC No:

Grade of assessor:                                                                             Date                        /     /

Procedure observed (including indications)




                                                                 Safe - supervision     Minimal supervision         No supervision and manages
                                                                     required                required                     complications
Please TICK to indicate the standard            Not observed
                                                                        (BASIC)           (INTERMEDIATE)                   (ADVANCED)
of the trainee’s performance in each             or practice
                                                   unsafe
                 area
                                                                                       Distant -      Distant –      Partially          Totally
                                                               Direct      Immediate
                                                                                        often           rare       independent       independent

Indication for procedure discussed with
assessor


Obtaining informed consent


Appropriate preparation including
monitoring, analgesia and sedation


Technical skills and aseptic technique


Situation awareness and clinical judgement

Safety, including prevention and
management of complications

Care /investigations immediately post
procedure
Professionalism, communication and
consideration for with patient, relatives
and staff

Documentation in the notes


OVERALL CLINICAL CARE


Things done particularly well


Suggested areas for development


Assessor Signature:                                                       Trainee Signature:




                                                                          62
IBTICM Multi-source feedback (ICM MSF)


Date




Dear Colleague


Trainees in Intensive Care medicine – Multi–source feedback


Multi–source feedback is now a required part of the assessment process for trainees
in intensive care medicine and we would be grateful if you would take a few minutes
to complete the attached form.


The form is anonymous but we ask that you complete a limited number of personal
details to enable us to check that a suitable cross-section of people have been asked
to comment on the trainees’ performance.


Please return the form to -------------------------------------------------------in the envelope
provided


by (add date)-------------------------.




Thanks you for agreeing to complete this multi-source feedback form.


Yours faithfully,



-----------------------------------------------------------IBTICM
(add name)




                                                    63
                                                     IBTICM Multi-source feedback
                                                             (ICM MSF)
Name of trainee:                                                                  Year of Training:

Assessor details                  Male                          Female            GMC No:
Doctor specialty                                                                  Date                           /     /

                                            Nurse
Consultant
                                            (Theatres/PACU)                      Please use the free text part of this form to comment
                                                                                  on particularly good behaviour or any behaviour causing
SAS Grade                                   Nurse (ICU/HDU)
                                                                                  concern
                                                                                 If you want to comment on attitude please provide
SpR 4-5 (StR 6-7)                           Nurse (Ward)
                                                                                  evidence of behaviour. This should reflect the trainee’s
                                                                                  behaviour over time – not usually a single incident.
SpR 1-3 (StR 3-5)                           ODP
                                                                                 The trainee will receive private feedback, but you will
StR 1-2 (CT 1-2)                            Admin/Secretarial                     not identified
                                                                                 If enough observers regard a trainee as giving cause for
FY 1-2                                      Other                                 concern they will be offered help and support




                                                                                  Areas of concern
Please TICK to indicate the standard
of the trainee’s performance in each
                 area                                                                                                               Cannot
                                                           None               Some                          Major
                                                                                                                                   comment

Maintaining trust/professional
relationships with patients
   Listens
   Is polite and caring
   Shows respect for patients’ opinions,
    dignity and confidentiality
   Is unprejudiced and dresses
    appropriately

Verbal communication skills
         Gives understandable
    information
         Speaks good English, at an
    appropriate level for the patient

Team working/working with colleagues
          Respects others’ roles and
    works constructively in the team
         Hands over effectively and
    communicates well. Is unprejudiced,
    supportive and fair

Accessibility
           Is accessible
           Takes proper responsibility
           Only delegates appropriately
           Does not shirk duty
           Responds when called
           Arranges cover for absences



Comments




                                                                         64
    PEM CT3
    Mini-CEX Summative Descriptors for PEM CT3 Acute Presentations
       1. Abdominal pain
       2. Fever
       3. Breathlessness
       4. Pain

1 Abdominal pain

                    Expected behaviour

Initial approach             ABCD approach
                             Asks for vital signs

History                      Obtains history-patient, friends, family, paramedics- cover PMH
                             Obtains previous notes

Examination                  General appearance – listlessness, features of dehydration and shock
                             Detailed physical examination including assessment of dehydration
                             Abdominal examination for guarding and distention
                             Inguinal and testicular examination

Investigation       Asks for appropriate tests
                               FBC,
                               U&Es,
                               LFTs, ,
                               blood and urine culture
                               Abdominal x-ray for those with? obstruction

Clinical decision   Forms diagnosis and differential diagnosis for D&V including:
making and
                               Intussusception
judgement
                               Bacterial and viral gastroenteritis
                               Food poisoning
                               Pyelonephritis
                    For abdominal pain
                               hernia,
                               intussusception,
                               pyloric stenosis,
                               appendicitis,
                               UTI,
                               viral URTI,
                               lower lobe pneumonia

Communication       Effectively communicates with both patient and colleagues
                                                     65
Overall plan                     identifies immediate life threats and readily reversible causes
                                 Able to classify degree of dehydration and prescribe appropriately
                                 Stabilises and prepares for further investigation, treatment and
                                  admission.
                                 Identifies which patients can be safely discharged

Professionalism       Behaves in a professional manner


  2 Assessment of the febrile child

                       Expected behaviour

  Initial approach             ABCD approach, including GCS
                               Asks for vital signs including
                                    o   SPaO2,
                                    o   temperature,
                                    o   blood sugar.
                               Identifies patient that needs resuscitation

  History                      Obtains history- parents, friends, paramedics- cover PMH,
                               Obtains previous notes
                               Identifes if immune deficient/ high risk-sickle, DM, CSF shunts, cardiac
                                patients

  Examination                  General appearance
                               Detailed physical examination focus on looking for causes of fever-
                                    o   ENT,
                                    o   neck stiffness,
                                    o   chest for resp and cardiac causes,
                                    o   abdomen,CNS,
                                    o   joints,
                                    o   Skin/rash

  Investigation                Asks for appropriate tests
                                    o   arterial blood gas,
                                    o   FBC,
                                    o   U&Es,
                                    o   clotting studies,
                                    o   LFTs,
                                    o   toxicology,
                                    o   blood and urine culture
                               Appropriate imaging

                                                       66
                                  o     Chest x-ray

Clinical decision    Forms diagnosis and differential diagnosis including:
making and
                     Infection
judgement
                     Bacterial
                                otitis media,
                                UTI,
                                pneumonia,
                                meningitis,
                                cellulitis,
                                joint infection,
                                appendicitis
                     Viral
                                chickenpox,
                                gastroenteritis
                     Others
                                neoplastic,
                                salicylates,
                                hyperthyroidism
                     Demonstrates knowledge of NICE guidelines for management of febrile child

Communication        Effectively communicates with both child, parents and colleagues

Overall plan         Stabilisies and prepares for further investigation, treatment and admission

Professionalism      Behaves in a professional manner


3 Assessment of the breathless child

                       Expected behaviour

Initial approach              ABCD approach focusing on
                                   o    airway patency,
                                   o    effort and efficacy of breathing,
                                   o    effects of inadequate respiration
                                   o    and cardiovascular status.
                              Ensures patent airway and high flow oxygen. Ensures monitoring

History                Obtains history- parents, paramedics

Examination                   General appearance
                              Detailed physical examination with detection of
                                   o    stridor & wheeze,

                                                      67
                                    o   signs of cardiac failure

Investigation                  Asks for appropriate tests-
                                    o   arterial blood gas,
                                    o   FBC,
                                    o   U&Es,
                                    o   clotting studies,
                                    o   blood and urine culture,
                                    o   blood sugar
                               Appropriate imaging Cxray

Clinical decision       Forms diagnosis and differential diagnosis including:
making and
                                   Stridor: croup/epiglottitis
judgement
                                   Wheeze: asthma/bronchiolitis
                                   Fever :pneumonia
                        Demonstrates knowledge of guidelines eg NICE for management of asthma.
                        Knows of croup scoring system

Communication           Effectively communicates with both child, parents and colleagues

Overall plan            Stabilises and prepares for further investigation, treatment and admission.
                        Seeks senior help early and appropriately

Professionalism         Behaves in a professional manner


4 Assessment of the child in pain

                        Expected behaviour

Initial approach        Recognises child in pain including behavioural and physiological changes

History                         Obtains history of the condition causing pain
                                Elicits past history of painful experiences and successful relieving
                                 measures

Examination                     Able to determine the cause of pain
                                Able to undertake pain assessment including the use of pain ladder and
                                 faces scale

Investigation                   Appropriate to the presentation

Clinical decision               Ensures parent involvement
making and
                                Selects most appropriate analgesic and route of administration
judgement
                                Demonstrates comprehensive knowledge of drugs and dosages
                                Calculates dosage correctly
                                Considers use of distractive techniques

                                                      68
Communication     Communicates effectively to both the child and parents. Sensitive and
                  reassuring

Overall plan      Ensures effective analgesia by repeated assessment and additional
                  treatment if needed

Professionalism   Behaves in a professional manner




                                          69
    PEM CT3
    Practical Procedures DOPs descriptors
       1. Venous access
       2. Airway assessment and maintenance,
       3. Safe sedation in children,
       4. Paediatric equipment and guidelines in the resuscitation room.
       5. Primary survey in a child

1 Venous access in children                                                             Task
                                                                                      completed

Trainee should identify suitable sites for cannulation in a child- specifically
    the dorsum of the hand and foot,
    cubital fossae,
    external jugular,
    scalp veins,
    femoral vein
    and IO.
S/he should select appropriate route depending on the clinical case

For the fully conscious patient:
    Should ensure adequate pain relief if appropriate- using topical anaesthetic
    Should ensure clean site and use aseptic technique
    Prepares equipment- cannulae, connections, steristrips, flush and blood
     collection bottles
    Immobilisation of limb using other members of staff
    Gains access, takes samples, connects, secures and flushes to ensure correct
     position
    Splints limb
    Writes up fluid to be administered (if any).


For those undergoing resuscitation (this dops will be unplanned but should not stop
this valuable learning opportunity from being missed)
a. femoral vein cannulation
        Demonstrates correct anatomy and proposed site of puncture
        Should ensure clean site and use aseptic technique
        Prepares equipment- cannulae, connections, steristrips, flush and blood
         collection bottles
        Immobilisation of limb using other members of staff
        Gains access, takes samples, connects, secures and flushes to ensure
         correct position
b. Intraosseous insertion using either IO needle or EZ drill
        Demonstrates correct anatomy and proposed site of insertion over the

                                                    70
        medial tibia.
       Should ensure clean site and use aseptic technique
       Prepares equipment- IO needle, connections, flush and syringe for
        collection of marrow blood
       Successfully inserts, confirms secure and patent. Connects to giving set and
        three way tap, and gives fluid bolus
       Knows complications of IO insertion
If trainees can not do IO needle insertion on real patient then they must
demonstrate to their trainer they can do so using a mannequin


2 Basic airway manoevers in children                                                     Task
                                                                                       completed

   Preparation- can size nasophrayngeal and oral airways
   Can select appropriate BVM
   On arrival assesses airway for patency
   Established if obstructed or not.
   Uses suction,adjuncts and positioning appropriately
   Ensures patent airway
   Administers high flow oxygen with appropriate mask
   Supports ventilation with BVM
   Ensures concurrent monitoring including SpAO2, ECG
   Correctly identifies those that will need intubation
   Works effectively with medical and nursing colleagues to deliver effective care


3 Paediatric sedation using ketamine

Pre procedure                  Demonstrates knowledge of CEM guidelines and has witnessed
preparation                     previous sedation in children
                               Has successfully completed paediatric airway care during
                                anaesthesia training

Procedure preparation          Checks indications and contraindications
and induction
                               Knows complications and their treatment
                               Ensures monitoring and appropriate staff
                               Obtains written consent from parents
                               Child weighed and dose calculated
                               Topical local anaesthetic
                               Intramuscular Ketamine and Atropine

Procedure management           Commence monitoring-
                                    o   ECG, S

                                                 71
                                       o   pAO2,
                                       o   oxygen
                                  Assess sedation
                                  Need for additional sedation?
                                  Sedation adequate –proceed
                                  Sedation inadequate- stop and seek advice re GA
                                  Use of local anaesthesia to the area to be treated
                                  Ensures monitoring throughout

 Procedure recovery               Placed in recovery position
                                  Quiet environment
                                  Continued monitoring
                                  Ensures recovery
                                  Allowed home when able to walk
                                  Written discharge information for parents


 4 Equipment and guidelines in the resuscitation room.

 This is designed to ensure the trainee is familiar with and can access important                Task
 paediatric resuscitation information and equipment                                            completed

 The trainee must demonstrate that:
    Can calculate the child’s weight, defibrillation energy, ETT size, fluid bolus, dose of
     adrenaline, dose of 10% dextrose to correct hypoglycaemia
    Can attach paediatric defibrillation paddles to adult paddles
    Can size and use o/p, n/p airways and use BVM
    They can find IO needle set
    That they know/ can find the normal range of physiological variables
    Can immediately access and know the common paediatric protocols- for cardiac
     arrest, seizures and anaphylaxis
    They can interpret limb xrays- specifically recognise epiphyses, joint effusions.
    That they can interpret lat cspine (age <10)
    That they recognise the normal paediatric ECG and how it changes


5 Perform a primary survey in a child

                   Expected behaviour

Preparation           Has calculated weight – prepared – defibrillation charge, ETT, fluid bolus, and
phase                  dextrose (10%)
                      Has Broselow tape and knows how to use it

                                                     72
Transfer            Ensures safe transfer of patient onto ED trolley

Examination            Assesses airway, establishes if obstructed, corrects and ensures delivery of
                        100%O2. Appropriate use and correct sizing of airway adjuncts
                       Concurrently ensures cervical spine immoblisation (using collar, sandbags and
                        tape)- able to select and apply correct collar
                       Exposes chest identified raised respiratory rate, chest asymmetry, chest wall
                        bruising, air entry (anteriorly and laterally) and percussion (laterally).
                        Identifies life threatening problems and correctly carries out associated
                        procedures
                       Examines for signs of shock, ensures monitoring established and has gained iv
                        accessX2
                       If shocked looks for potential sites of blood loss- abdomen, pelvis and limbs.
                       Can formulate differential for shocked patient
                       Knows protocol for fluid administration for the shocked child
                       Establishes level of consciousness and seeks lateralising signs
                       Uses paediatric GCS scale
                       Examines limbs, spine and rectum (if unconscious or spinal injury
                        suspected)ensuring safe log roll.
                       BM done for those with altered level of consciousness
                       Will have identified and searched for potential life threatening problems in a
                        systematic and prioritised way
                       Ensured child is kept warm
                       Reassesses if any deterioration with repeat of ABCD
                       Elicits full relevant history from prehospital care providers, witnesses and
                        parents

Monitoring and         Ensured appropriate monitoring
interventions
                       Will have placed lines, catheter and NG tubes as appropriate



Investigations         Ensured appropriate blood testing (including cross match).
                       Plain radiology trauma series undertaken

Prescribing         Ensures adequate and safe pain relief

Clinical decision      Directs team appropriately
making and
                       Liaises with and involves parents
judgement


Overall plan        Notes of primary survey are clear and legible

Professionalism     Behaves in a professional manner




                                                    73
PEM ST7 Assessments




                      74
75
76
77
                                College of Emergency Medicine
                          Structured Training Report for ACCS EM CT1
       The Educational Supervisor must complete this STR, having reviewed the trainees e-portfolio
Trainees Name and GMC Number

Educational Supervisor name
and GMC Number

Deanery / School

Training Unit

GMC programme /Post approval number

Date of assessment

Period covered in this assessment, start and end dates



ARCP decision tool for EM CT1

Assessments and number required                           Number     Outcome   Comments
                                                         completed

Common Competences CC 1-25
More than 1/3 to level 2 in CT1&2
Please see section below

Core Major Presentations Adult (CMP1-6)
    2/6 summative in EM CT1

Core Acute Presentations CAP Adults 1-38
    5/38 summative in CT1, in specified topics
    X1 ACAT-EM covering 5/38 APs
    Additional 10/38 using ACAT, e-learning etc

CT3 Additional Emergency Presentations
C3AP Adult = 1-7
None required in CT1

Adult Practical Procedures = 45
    5 EM DOPs required (4 specified + additional)

Min assessments in EM CT1 = 13
2 MPs, 5 APs, 1 ACAT, 5 DOPs

Paediatric Major Presentations PMP 1-6
None required in CT1

Paediatric Acute Presentations PAP 1-19
None required in CT1

Practical procedures in children = 5 specified
None required in CT1



                                                             78
Management and leadership

Examinations = MCEM A

E-learning modules
30 from CEM hub for each year

Safeguarding Children
Level 1&2

Life support courses
ALS

Minimum number of assessments by consultants
13 in EM

Experience
800 patient in 6/12 EM
Please review trainees log book or equivalent*

MSF x1 year

Other outcome to be considered

Activity                                                     Date               Outcome               Comments

PDP

Educational achievements

Evidence of reflective practice

Critical incidents

Complaints

Periods of absence form the post, include sick leave
Out of programme time, but not annual leave
       * trainee must provide either an hard copy or electronic log book, indicating number of patients seen and in what clinical areas,
       e.g. resus, majors, paeds or minors



       Common Competences progression
       Completion of the EM WPBA tools on the e-portfolio will automatically populate the
       trainee’s common competences framework. Using this framework and knowledge of the
       trainees competence against the common competency curriculum the following table
       should describe the level at which the trainee is working at present i.e. level 1-4.

                                                         Competence                                 Comments (if any)
                     Domain                                level 1-4

History taking

Clinical examination

Therapeutics and safe prescribing

Time management and decision making

                                                                      79
Decision making and clinical reasoning

The patient as central focus of care

Prioritisation of patient safety in clinical
practice

Team working and patient safety

Principles of quality and safety improvement

Infection control

Managing long term conditions and
promoting patient self-care

Relationships with patients and
communication within a consultation

Breaking bad news

Complaints and medical error

Communication with colleagues and
cooperation

Health promotion and public health

Principles of medical ethics and
confidentiality

Valid consent

Legal framework for practice

Ethical research

Evidence and guidelines

Audit

Teaching and training

Personal behaviour

Management and NHS structure




Strengths of trainee




Weaknesses of trainee




                                               80
Suggestions for development




Issues not covered elsewhere




Does the ES recommendation to ARCP panel for this trainee to           Yes   No
progress to next stage of training

If no, reasons why and specific areas that need to be addressed




ES Name and Signature                              Trainee Signature




Date:                                              Date:




                                                 81
                                College of Emergency Medicine
                          Structured Training Report for ACCS AM CT1
       The Educational Supervisor must complete this STR, having reviewed the trainees e-portfolio
Trainees Name and GMC Number

Educational Supervisor name
and GMC Number

Deanery / School

Training Unit

GMC programme /Post approval number

Date of assessment

Period covered in this assessment, start and end dates



ARCP decision tool for AM CT1

Assessments and number required                           Number     Outcome   Comments
                                                         completed

Common Competences CC 1-25
More than 1/3 to level 2 in CT1&2
Please see section below

Core Major Presentations Adult (CMP1-6)
    2/6 formative in AM CT1 (but can use the
     summative descriptor tools from EM)

Core Acute Presentations CAP Adults 1-38
    10/38 formative using Mini-CEX, CbD or ACAT
    Additional 10/38 using ACAT, e-learning etc

CT3 Additional Emergency Presentations
C3AP Adult = 1-7
None required in CT1

Adult Practical Procedures = 45
    5 DOPs

Min assessments in AM CT1 = 14
x3 CEX, x3 CbD, x5 DOPs, x3 ACATs

Paediatric Major Presentations PMP 1-6
None required in CT1

Paediatric Acute Presentations PAP 1-19
None required in CT1

Practical procedures in children = 5 specified
None required in CT1

Management and leadership

                                                             82
Examinations = MCEM A

E-learning modules
30 from CEM hub per year

Safeguarding Children
Level 1&2

Life support courses
ALS

Minimum number of assessments by consultants
Not specified for AM

Experience
Number of patient no specified for AM

MSF x1 year

Other outcome to be considered

Activity                                                     Date               Outcome               Comments

PDP

Educational achievements

Evidence of reflective practice

Critical incidents

Complaints

Periods of absence form the post, include sick leave
Out of programme time, but not annual leave
       * trainee must provide either an hard copy or electronic log book, indicating number of patients seen and in what clinical areas,
       e.g. resus, majors, paeds or minors




       Common Competences progression
       Completion of the EM WPBA tools on the e-portfolio will automatically populate the
       trainee’s common competences framework. Using this framework and knowledge of the
       trainees competence against the common competency curriculum the following table
       should describe the level at which the trainee is working at present i.e. level 1-4.

                                                         Competence                                 Comments (if any)
                     Domain                                level 1-4

History taking

Clinical examination

Therapeutics and safe prescribing

Time management and decision making


                                                                      83
Decision making and clinical reasoning

The patient as central focus of care

Prioritisation of patient safety in clinical
practice

Team working and patient safety

Principles of quality and safety improvement

Infection control

Managing long term conditions and
promoting patient self-care

Relationships with patients and
communication within a consultation

Breaking bad news

Complaints and medical error

Communication with colleagues and
cooperation

Health promotion and public health

Principles of medical ethics and
confidentiality

Valid consent

Legal framework for practice

Ethical research

Evidence and guidelines

Audit

Teaching and training

Personal behaviour

Management and NHS structure




 Strengths of trainee




 Weaknesses of trainee




                                               84
Suggestions for development




Issues not covered elsewhere




Does the ES recommendation to ARCP panel for this trainee to           Yes   No
progress to next stage of training

If no, reasons why and specific areas that need to be addressed




ES Name and Signature                              Trainee Signature




Date:                                              Date:




                                                 85
                             College of Emergency Medicine
                   Structured Training Report for ACCS Anaesthesia CT2
       The Educational Supervisor must complete this STR, having reviewed the trainees e-portfolio
Trainees Name and GMC Number

Educational Supervisor name
and GMC Number

Deanery / School

Training Unit

GMC programme /Post approval number

Date of assessment

Period covered in this assessment, start and end dates



ARCP decision tool for Anaesthesia CT2

Assessments and number required                           Number     Outcome   Comments
                                                         completed

Common Competences CC 1-25
More than 2/3 to level 2 by end of CT2
Please see section below

Initial assessment of competence certificate

Summative Mini-CEX x3
    Management of spont vent patient
    Management of intubated patient
    Management of emergency surgical case

Summative CbDs x7

Summative Practical procedures 5/45
    5 anaesthetic DOPs

Min assessments in Anaesthesia CT2 = 16
1 IAC, x3 CEX, x7 CbD, x5 DOPs

Paediatric Major Presentations PMP 1-6
None required in CT1

Paediatric Acute Presentations PAP 1-19
None required in CT1

Practical procedures in children = 5 specified
None required in CT1

Management and leadership

Examinations = MCEM A



                                                             86
E-learning modules
30 from CEM hub per year

Safeguarding Children
Level 1&2

Life support courses
ALS

Minimum number of assessments by consultants
Not specified for Anaesthesia

Experience
Number of patient not specified for anaesthesia

MSF x1 year

Other outcome to be considered

Activity                                                     Date               Outcome               Comments

PDP

Educational achievements

Evidence of reflective practice

Critical incidents

Complaints

Periods of absence form the post, include sick leave
Out of programme time, but not annual leave
       * trainee must provide either an hard copy or electronic log book, indicating number of patients seen and in what clinical areas,
       e.g. resus, majors, paeds or minors


       Common Competences progression
       Completion of the EM WPBA tools on the e-portfolio will automatically populate the
       trainee’s common competences framework. Using this framework and knowledge of the
       trainees competence against the common competency curriculum the following table
       should describe the level at which the trainee is working at present i.e. level 1-4.

                                                         Competence                                 Comments (if any)
                     Domain                                level 1-4

History taking

Clinical examination

Therapeutics and safe prescribing

Time management and decision making

Decision making and clinical reasoning

The patient as central focus of care

Prioritisation of patient safety in clinical

                                                                      87
practice

Team working and patient safety

Principles of quality and safety improvement


Infection control

Managing long term conditions and
promoting patient self-care

Relationships with patients and
communication within a consultation

Breaking bad news

Complaints and medical error

Communication with colleagues and
cooperation

Health promotion and public health

Principles of medical ethics and
confidentiality

Valid consent

Legal framework for practice

Ethical research

Evidence and guidelines

Audit

Teaching and training

Personal behaviour

Management and NHS structure




 Strengths of trainee




 Weaknesses of trainee




 Suggestions for development



                                               88
Issues not covered elsewhere




Does the ES recommendation to ARCP panel for this trainee to           Yes   No
progress to next stage of training

If no, reasons why and specific areas that need to be addressed




ES Name and Signature                              Trainee Signature




Date:                                              Date:




                                                 89
                                College of Emergency Medicine
                         Structured Training Report for ACCS ICM CT2
       The Educational Supervisor must complete this STR, having reviewed the trainees e-portfolio
Trainees Name and GMC Number

Educational Supervisor name
and GMC Number

Deanery / School

Training Unit

GMC programme /Post approval number

Date of assessment

Period covered in this assessment, start and end dates



ARCP decision tool for ICM CT2

Assessments and number required                           Number     Outcome   Comments
                                                         completed

Common Competences CC 1-25
More than 2/3 by end of CT2
Please see section below

Core Major Presentations Adult (CMP1-6)
    2/6 formative in ICM CT2 (but can use the
     summative descriptor tools from EM)

Core Acute Presentations CAP Adults 1-38
    Any remaining APs not already covered using
     a formative tool

CT3 Additional Emergency Presentations
C3AP Adult = 1-7
None required in CT1

Adult Practical Procedures = 45
    13 using DOPs or other tools

Min assessments in ICM CT2 = 15
2 MPs, 13 PP

Paediatric Major Presentations PMP 1-6
None required in CT1

Paediatric Acute Presentations PAP 1-19
None required in CT1

Practical procedures in children = 5 specified
None required in CT1

Management and leadership

                                                             90
Examinations = MCEM A

E-learning modules
30 from CEM hub for each year

Safeguarding Children
Level 1&2

Life support courses
ALS

Minimum number of assessments by consultants
Not specified for ICM

Experience
Number of cases not specified for ICM

MSF x1 year

Other outcome to be considered

Activity                                                     Date               Outcome               Comments

PDP

Educational achievements

Evidence of reflective practice

Critical incidents

Complaints

Periods of absence form the post, include sick leave
Out of programme time, but not annual leave
       * trainee must provide either an hard copy or electronic log book, indicating number of patients seen and in what clinical areas,
       e.g. resus, majors, paeds or minors


       Common Competences progression
       Completion of the EM WPBA tools on the e-portfolio will automatically populate the
       trainee’s common competences framework. Using this framework and knowledge of the
       trainees competence against the common competency curriculum the following table
       should describe the level at which the trainee is working at present i.e. level 1-4.

                                                         Competence                                 Comments (if any)
                     Domain                                level 1-4

History taking

Clinical examination

Therapeutics and safe prescribing

Time management and decision making

Decision making and clinical reasoning

The patient as central focus of care

                                                                      91
Prioritisation of patient safety in clinical
practice

Team working and patient safety

Principles of quality and safety improvement


Infection control

Managing long term conditions and
promoting patient self-care

Relationships with patients and
communication within a consultation

Breaking bad news

Complaints and medical error

Communication with colleagues and
cooperation

Health promotion and public health

Principles of medical ethics and
confidentiality

Valid consent

Legal framework for practice

Ethical research

Evidence and guidelines

Audit

Teaching and training

Personal behaviour

Management and NHS structure




Strengths of trainee




Weaknesses of trainee




Suggestions for development


                                               92
Issues not covered elsewhere




Does the ES recommendation to ARCP panel for this trainee to               Yes   No
progress to next stage of training

If no, reasons why and specific areas that need to be addressed




ES Name and Signature                                  Trainee Signature




Date:                                                  Date:




                                                  93
                                College of Emergency Medicine
                         Structured Training Report for ACCS PEM CT3
       The Educational Supervisor must complete this STR, having reviewed the trainees e-portfolio
Trainees Name and GMC Number

Educational Supervisor name
and GMC Number

Deanery / School

Training Unit

GMC programme /Post approval number

Date of assessment

Period covered in this assessment, start and end dates



ARCP decision tool for PEM CT3

Assessments and number required                           Number     Outcome   Comments
                                                         completed

Common Competences CC 1-25
Completed all to level 2 by end of CT3
Please see section below

Core Major Presentations Adult (CMP1-6)
    All 6/6 by end of CT2

Core Acute Presentations CAP Adults 1-38
    At least 20/38 must be covered by end of CT2
    Any remaining must be covered by end of CT3

CT3 Additional Emergency Presentations
C3AP Adult = 1-7
None required in PEM

Adult Practical Procedures = 45
    5 EM DOPs required (4 specified + additional)
     by end of CT2

Paediatric Major Presentations PMP 1-6
    APLS /EPLS
    Or 3/6 PMPs using summative Mini-CEX or CbD

Paediatric Acute Presentations PAP 1-19
    X4 summative APs using Mini-CEX/CbD (topics
     specified)
    X1 ACAT to cover 5 APs (specified) or can use
     Mini-CEX/CbD

Practical procedures in children = 5 specified
    X5 formative EM DOPs (topics specified)

                                                             94
Minimum assessments for PEM CT3 = 11
X1 LS, x4 Summative, x1 ACAT, x5 DOPs

Management and leadership

Examinations = MCEM B&C

E-learning modules
30 from CEM hub for each year

Safeguarding Children
Level 1&2

Life support courses
ALS/ ATLS/ APLS

Minimum number of assessments by consultants
11 in PEM

Experience
750 paeds cases in 6/12 PEM
Of which 20 should be in Resus
Please review trainees log book or equivalent*

MSF x1 year

Other outcome to be considered

Activity                                                     Date               Outcome               Comments

PDP

Educational achievements

Evidence of reflective practice

Critical incidents

Complaints

Periods of absence form the post, include sick leave
Out of programme time, but not annual leave
       * trainee must provide either an hard copy or electronic log book, indicating number of patients seen and in what clinical areas,
       e.g. resus, majors, paeds or minors


       Common Competences progression
       Completion of the EM WPBA tools on the e-portfolio will automatically populate the
       trainee’s common competences framework. Using this framework and knowledge of the
       trainees competence against the common competency curriculum the following table
       should describe the level at which the trainee is working at present i.e. level 1-4.

                                                         Competence                                 Comments (if any)
                     Domain                                level 1-4

History taking

Clinical examination

                                                                      95
Therapeutics and safe prescribing

Time management and decision making

Decision making and clinical reasoning

The patient as central focus of care

Prioritisation of patient safety in clinical
practice

Team working and patient safety

Principles of quality and safety improvement


Infection control

Managing long term conditions and
promoting patient self-care

Relationships with patients and
communication within a consultation

Breaking bad news

Complaints and medical error

Communication with colleagues and
cooperation

Health promotion and public health

Principles of medical ethics and
confidentiality

Valid consent

Legal framework for practice

Ethical research

Evidence and guidelines

Audit

Teaching and training

Personal behaviour

Management and NHS structure




 Strengths of trainee




 Weaknesses of trainee

                                               96
Suggestions for development




Issues not covered elsewhere




Does the ES recommendation to ARCP panel for this trainee to           Yes   No
progress to next stage of training

If no, reasons why and specific areas that need to be addressed




ES Name and Signature                              Trainee Signature




Date:                                              Date:




                                                 97
                                College of Emergency Medicine
                          Structured Training Report for ACCS EM CT3
       The Educational Supervisor must complete this STR, having reviewed the trainees e-portfolio
Trainees Name and GMC Number

Educational Supervisor name
and GMC Number

Deanery / School

Training Unit

GMC programme /Post approval number

Date of assessment

Period covered in this assessment, start and end dates



ARCP decision tool for EM CT3

Assessments and number required                           Number     Outcome   Comments
                                                         completed

Common Competences CC 1-25
Completed all to level 2 by end of CT3
Please see section below

Core Major Presentations Adult (CMP1-6)
    All 6/6 by end of CT2

Core Acute Presentations CAP Adults 1-38
    At least 20/38 must be covered by end of CT2
    Any remaining must be covered by end of CT3

CT3 Additional Acute Presentations
C3AP Adult = 1-7
    X1 summative assessment in trauma
    X1 ACAT to cover 3 specified topics (or Mini-
     CEX/CbD)

Adult Practical Procedures = 45
    Increase coverage of remaining PP

Paediatric Major Presentations PMP 1-6
    None require for EM CT3

Paediatric Acute Presentations PAP 1-19
    None required for EM CT3

Practical procedures in children = 5 specified
    None required for EM CT3

Minimum assessments for EM CT3 = 2
X1 summative Trauma, x1 ACAT

                                                             98
Management and leadership

Examinations = MCEM B&C

E-learning modules
30 from CEM hub for each year

Safeguarding Children
Level 1&2

Life support courses
ALS/ ATLS/ APLS

Minimum number of assessments by consultants
1 summative

Experience
800 patient in 6/12
Please review trainees log book or equivalent*

MSF x1 year

Other outcome to be considered

Activity                                                     Date               Outcome               Comments

PDP

Educational achievements

Evidence of reflective practice

Critical incidents

Complaints

Periods of absence form the post, include sick leave
Out of programme time, but not annual leave
       * trainee must provide either an hard copy or electronic log book, indicating number of patients seen and in what clinical areas,
       e.g. resus, majors, paeds or minors



       Common Competences progression
       Completion of the EM WPBA tools on the e-portfolio will automatically populate the
       trainee’s common competences framework. Using this framework and knowledge of the
       trainees competence against the common competency curriculum the following table
       should describe the level at which the trainee is working at present i.e. level 1-4.

                                                         Competence                                 Comments (if any)
                      Domain                               level 1-4

History taking

Clinical examination

Therapeutics and safe prescribing

Time management and decision making

                                                                      99
Decision making and clinical reasoning

The patient as central focus of care

Prioritisation of patient safety in clinical
practice

Team working and patient safety

Principles of quality and safety improvement


Infection control

Managing long term conditions and
promoting patient self-care

Relationships with patients and
communication within a consultation

Breaking bad news

Complaints and medical error

Communication with colleagues and
cooperation

Health promotion and public health

Principles of medical ethics and
confidentiality

Valid consent

Legal framework for practice

Ethical research

Evidence and guidelines

Audit

Teaching and training

Personal behaviour

Management and NHS structure




 Strengths of trainee




 Weaknesses of trainee




                                               100
Suggestions for development




Issues not covered elsewhere




Does the ES recommendation to ARCP panel for this trainee to           Yes   No
progress to next stage of training

If no, reasons why and specific areas that need to be addressed




ES Name and Signature                              Trainee Signature




Date:                                              Date:




                                                101
                                   College of Emergency Medicine
                                Structured Training Report for ST4 EM
         The Educational Supervisor must complete this STR, having reviewed the trainees e-portfolio
Trainees Name and GMC Number

Educational Supervisor name
and GMC Number

Deanery / School

Training Unit

GMC programme /Post approval number

Date of assessment

Period covered in this assessment, start and end dates



ARCP decision tool for EM ST4

Assessments and number required                           Number     Outcome   Comments
                                                         completed

Common Competences CC 1-25
    Assessed to Level 3 / 4 descriptors in 50%

HST Major presentations HMP1-5
    X3 formative assessments, only CEX or CbD

HST Acute Presentations - adult HAP 1-33
    X9 topics covered using formative
     assessments tools of CEX, CbD or ACAT
    x8 topics sampled using e-modules, reflective
     learning, audit, teaching or ACAT

HST Paediatric Acute Presentations PAP = 10
    X5 topics covered using formative
     assessments tolls of CEX, CbD or ACAT

Procedures
    Practical procedures in more complex cases-
     all should be recorded.
    Commences ultrasound scanning of patients –
     record/assessment
           o      Section A completed.
           o      Commences triggered assessments

Clinical skills
     o     Able to look after several patients
           concurrently.
     o     Supervises others

Safeguarding Children
     o     Level 3 by CCT


                                                            102
Management and leadership
      o      Review HST management portfolio

MSF
      o      X1 a year

Patient Survey
      o      X1 by end of training

Examination
      o      Commences work on Clinical Topic
             Review.
      o      Critical appraisal skills developed

E-learning modules
      o      30 a year from CEM HUB

Life support
      o      Holds valid ALS/ATLS/APLS provider

Experience
      o      See >2000 cases /year of which 10% are
             cases in the resuscitation room*
* these are indicative numbers and a judgement
on these numbers needs to be made at ARCP

Other outcome to be considered

Activity                                                        Date               Outcome               Comments

PDP

Educational achievements

Evidence of reflective practice

Critical incidents

Complaints

Periods of absence form the post, include sick leave
Out of programme time, but not annual leave
          * trainee must provide either an hard copy or electronic log book, indicating number of patients seen and in what clinical areas,
          e.g. resus, majors, paeds or minors


          Common Competences progression
          Completion of the EM WPBA tools on the e-portfolio will automatically populate the
          trainee’s common competences framework. Using this framework and knowledge of the
          trainees competence against the common competency curriculum the following table
          should describe the level at which the trainee is working at present i.e. level 1-4.

                                                            Competence                                 Comments (if any)
                         Domain                               level 1-4

History taking

Clinical examination

                                                                        103
Therapeutics and safe prescribing

Time management and decision making

Decision making and clinical reasoning

The patient as central focus of care

Prioritisation of patient safety in clinical
practice

Team working and patient safety

Principles of quality and safety improvement


Infection control

Managing long term conditions and
promoting patient self-care

Relationships with patients and
communication within a consultation

Breaking bad news

Complaints and medical error

Communication with colleagues and
cooperation

Health promotion and public health

Principles of medical ethics and
confidentiality

Valid consent

Legal framework for practice

Ethical research

Evidence and guidelines

Audit

Teaching and training

Personal behaviour

Management and NHS structure




 Strengths of trainee




 Weaknesses of trainee

                                               104
Suggestions for development




Issues not covered elsewhere




Does the ES recommendation to ARCP panel for this trainee to           Yes   No
progress to next stage of training

If no, reasons why and specific areas that need to be addressed




ES Name and Signature                              Trainee Signature




Date:                                              Date:




                                                105
                                   College of Emergency Medicine
                                Structured Training Report for ST5 EM
         The Educational Supervisor must complete this STR, having reviewed the trainees e-portfolio
Trainees Name and GMC Number

Educational Supervisor name
and GMC Number

Deanery / School

Training Unit

GMC programme /Post approval number

Date of assessment

Period covered in this assessment, start and end dates



ARCP decision tool for EM ST5

Assessments and number required                           Number     Outcome   Comments
                                                         completed

Common Competences CC 1-25
    All assessed to Level 3 / 4 descriptors by end
     of ST5

HST Major presentations HMP1-5
    X2 formative assessments, only CEX or CbD

HST Acute Presentations - adult HAP 1-33
    X8 topics covered using formative
     assessments tools of CEX, CbD or ACAT
    x8 topics sampled using e-modules, reflective
     learning, audit, teaching or ACAT

HST Paediatric Acute Presentations PAP = 10
    X5 topics covered using formative
     assessments tolls of CEX, CbD or ACAT

Procedures
    Practical procedures in more complex cases-
     all should be recorded.
    Continues ultrasound scanning of patients –
     record/assessment- completion of triggered
     assessments and final sign off

Clinical skills
     o     Looking after complex cases that are
           greyer and sicker- covering all
           presentations and procedures

Safeguarding Children
     o     Level 3 by CCT

Management and leadership


                                                            106
      o      Review HST management portfolio

MSF
      o      X1 a year

Patient Survey
      o      X1 by end of training

Examination
      o      CTR advanced with personal work
             completed.
      o      Submits to FCEM Critical Appraisal
             written examination

E-learning modules
      o      30 a year from CEM HUB

Life support
      o      Holds valid ALS/ATLS/APLS provider
      o      Ideally instructor in x1 LS

Experience
      o      See >2000 cases /year of which 10% are
             cases in the resuscitation room*
* these are indicative numbers and a judgement
on these numbers needs to be made at ARCP

Other outcome to be considered

Activity                                                        Date               Outcome               Comments

PDP

Educational achievements

Evidence of reflective practice

Critical incidents

Complaints

Periods of absence form the post, include sick leave
Out of programme time, but not annual leave
          * trainee must provide either an hard copy or electronic log book, indicating number of patients seen and in what clinical areas,
          e.g. resus, majors, paeds or minors


          Common Competences progression
          Completion of the EM WPBA tools on the e-portfolio will automatically populate the
          trainee’s common competences framework. Using this framework and knowledge of the
          trainees competence against the common competency curriculum the following table
          should describe the level at which the trainee is working at present i.e. level 1-4.

                                                            Competence                                 Comments (if any)
                         Domain                               level 1-4

History taking



                                                                        107
Clinical examination

Therapeutics and safe prescribing

Time management and decision making

Decision making and clinical reasoning

The patient as central focus of care

Prioritisation of patient safety in clinical
practice

Team working and patient safety

Principles of quality and safety improvement


Infection control

Managing long term conditions and
promoting patient self-care

Relationships with patients and
communication within a consultation

Breaking bad news

Complaints and medical error

Communication with colleagues and
cooperation

Health promotion and public health

Principles of medical ethics and
confidentiality

Valid consent

Legal framework for practice

Ethical research

Evidence and guidelines

Audit

Teaching and training

Personal behaviour

Management and NHS structure




 Strengths of trainee




                                               108
Weaknesses of trainee




Suggestions for development




Issues not covered elsewhere




Does the ES recommendation to ARCP panel for this trainee to           Yes   No
progress to next stage of training

If no, reasons why and specific areas that need to be addressed




ES Name and Signature                              Trainee Signature




Date:                                              Date:




                                                109
                                 College of Emergency Medicine
                        Structured Training Report for ST6 (or above) EM
          The Educational Supervisor must complete this STR, having reviewed the trainees e-portfolio
Trainees Name and GMC Number

Educational Supervisor name
and GMC Number

Deanery / School

Training Unit

GMC programme /Post approval number

Date of assessment

Period covered in this assessment, start and end dates



ARCP decision tool for EM ST6

Assessments and number required                           Number     Outcome   Comments
                                                         completed

Common Competences CC 1-25
     All assessed to Level 3 / 4 descriptors by end
      of ST5

HST Major presentations HMP1-5
All covered by ST6

HST Acute Presentations - adult HAP 1-33
All covered by ST6

HST Paediatric Acute Presentations PAP = 10
All covered by ST6

Procedures
     Competent in ultrasound examination to level
      1.

Clinical skills
      o     Looking after complex cases that are
            greyer and sicker- covering all
            presentations and procedures

Safeguarding Children
      o     Level 3 by CCT

Management and leadership
      o     Review HST management portfolio

MSF
      o     X1 a year

Patient Survey
      o     X1 by end of training

                                                            110
Examination
      o      CTR complete and seen by ES
      o      FCEM

E-learning modules
      o      30 a year from CEM HUB

Life support
      o      Holds valid ALS/ATLS/APLS provider
      o      Instructor in x1 LS

Experience
      o      See >2000 cases /year of which 10% are
             cases in the resuscitation room*
* these are indicative numbers and a judgement
on these numbers needs to be made at ARCP

Other outcome to be considered

Activity                                                        Date               Outcome               Comments

PDP

Educational achievements

Evidence of reflective practice

Critical incidents

Complaints

Periods of absence form the post, include sick leave
Out of programme time, but not annual leave
          * trainee must provide either an hard copy or electronic log book, indicating number of patients seen and in what clinical areas,
          e.g. resus, majors, paeds or minors


          Common Competences progression
          Completion of the EM WPBA tools on the e-portfolio will automatically populate the
          trainee’s common competences framework. Using this framework and knowledge of the
          trainees competence against the common competency curriculum the following table
          should describe the level at which the trainee is working at present i.e. level 1-4.

                                                            Competence                                 Comments (if any)
                        Domain                                level 1-4

History taking

Clinical examination

Therapeutics and safe prescribing

Time management and decision making

Decision making and clinical reasoning

The patient as central focus of care



                                                                        111
Prioritisation of patient safety in clinical
practice

Team working and patient safety

Principles of quality and safety improvement


Infection control

Managing long term conditions and
promoting patient self-care

Relationships with patients and
communication within a consultation

Breaking bad news

Complaints and medical error

Communication with colleagues and
cooperation

Health promotion and public health

Principles of medical ethics and
confidentiality

Valid consent

Legal framework for practice

Ethical research

Evidence and guidelines

Audit

Teaching and training

Personal behaviour

Management and NHS structure




 Strengths of trainee




 Weaknesses of trainee




 Suggestions for development


                                               112
Issues not covered elsewhere




Does the ES recommendation to ARCP panel for this trainee to           Yes   No
progress to next stage of training

If no, reasons why and specific areas that need to be addressed




ES Name and Signature                              Trainee Signature




Date:                                              Date:




                                                113
                                   College of Emergency Medicine
                               Structured Training Report for PEM ST7
          The Educational Supervisor must complete this STR, having reviewed the trainees e-portfolio
Trainees Name and GMC Number

Educational Supervisor name
and GMC Number

Deanery / School

Training Unit

GMC programme /Post approval number

Date of assessment

Period covered in this assessment, start and end dates



ARCP decision tool for PEM ST7

Assessments and number required                            Number     Outcome   Comments
                                                          completed

PEM Common Competences 1-36
     Competent in all the competences listed 1-36
      of which previous evidence for standards 24-
      26 and 34-36 will be accepted
(ACAT/CBD/Mini-CEX/SAIL/DOPs/Porfolio/MSF)

PEM Acute Presentations
      o     X4 Mini-CEX - formative in topics specified
      o     X6 CbDs - formative in topics specified

HST Paediatric Acute Presentations PAP = 10
      o     All covered by ST6

Procedures
     X1 EM DOP or alternative tool against PP listed
      in PEM curriculum.

      5 SAIL letters

Safeguarding Children
      o     Level 3

Management and leadership
      o     Demonstrates leadership competency in
            all areas in relation to PEM

MSF
      o     X1 e Paed MSF a year

Patient Survey
      o     1 Paed CCF (previously SHEFFPAT/patient
            survey)


                                                             114
Examination
      None for PEM ST7

E-learning modules
      o      30 a year from CEM HUB

Life support
      o      Holds valid ALS/ATLS/APLS provider
      o      Instructor in x1 LS

Experience
      o      Should see >800 cases per 6/12 in EM
      o      Should have looked after >100 cases in
             the resuscitation room, PICU,HDU setting
             and be able to demonstrate this – by log
             book, computerised log books. All of
             these cases must originate in the
             resuscitation room cases (but can be
             involved from ED or PICU perspective)
* these are indicative numbers and a judgement
on these numbers needs to be made at ARCP

Other outcome to be considered

Activity                                                        Date               Outcome               Comments

PDP

Educational achievements

Evidence of reflective practice

Critical incidents

Complaints

Periods of absence form the post, include sick leave
Out of programme time, but not annual leave
          * trainee must provide either an hard copy or electronic log book, indicating number of patients seen and in what clinical areas,
          e.g. resus, majors, paeds or minors




 Strengths of trainee




 Weaknesses of trainee




 Suggestions for development


                                                                        115
Issues not covered elsewhere




Does the ES recommendation to ARCP panel that this trainee is          Yes   No
making satisfactory progress for SS Paeds training

If no, reasons why and specific areas that need to be addressed




ES Name and Signature                              Trainee Signature




Date:                                              Date:




                                                116

				
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